Sousa Pedro A, Puga Luís, Barra Sérgio, Adão Luís, Primo João, Khoueiry Ziad, Lebreiro Ana, Fonseca Paulo, Pereira Mariana, Lagrange Philippe, d'Avila Andre, Oliveiros Bárbara, Elvas Luís, Gonçalves Lino
Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
Int J Cardiol. 2023 Jan 1;370:209-214. doi: 10.1016/j.ijcard.2022.10.013. Epub 2022 Oct 10.
To compare the two different ablation strategies, both guided by the Ablation Index (AI), in the setting of atrial fibrillation (AF) ablation: high-power short-duration (HPSD) ablation using 40 W on the posterior wall and 50 W elsewhere versus low-power long-duration (LPLD) using 25 W posteriorly and 35 W elsewhere.
Prospective, multicenter nonrandomized, noninferiority study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. Ablation was guided by the AI (≥500 for anterior segments, ≥450 for the roof and inferior segments and 400 posteriorly) and an interlesion distance (ILD) ≤ 6 mm. Patients were separated into two groups: HPSD vs LPLD. Acute reconnection (after adenosine trial) and 2-year outcomes were assessed.
160 patients (61% males, median age of 62 [IQR 51-69] years), fulfilled the study inclusion criteria - 80 patients (316 pulmonary veins [PV]) in the HPSD group and 80 patients (314 PV) in the LPLD. The probability of acute PV reconnection was similar between both groups: 2.2% in HPSD, 95%CI 0.6% to 3.8% vs. 3.4% in LPLD, 95%CI 1.4% to 5.4%; p < 0.001 for noninferiority. Median PV ablation time (20 min vs 30 min, p < 0.01) and procedure duration (80 min vs 100 min, p < 0.001) were shorter in the HPSD group. After a median follow-up of 26 months, arrhythmia recurrence was similar between groups (17.5% in HPSD group vs. 18.8% in LPLD group, p = 0.79).
In paroxysmal AF patients treated with the Ablation Index, a HPSD strategy is noninferior to the more standard LPLD ablation, while allowing for quicker procedures with shorter ablation times.
在心房颤动（AF）消融治疗中，比较两种均由消融指数（AI）引导的不同消融策略：后壁采用40W、其他部位采用50W的高功率短持续时间（HPSD）消融与后壁采用25W、其他部位采用35W的低功率长持续时间（LPLD）消融。
对2018年1月至2019年7月因阵发性AF消融而转诊的连续患者进行前瞻性、多中心、非随机、非劣效性研究。消融由AI（前壁节段≥500，房顶和下壁节段≥450，后壁400）和病灶间距离（ILD）≤6mm引导。患者分为两组：HPSD组和LPLD组。评估急性再连接（腺苷试验后）和2年结局。
160例患者（61%为男性，中位年龄62岁[四分位间距51 - 69岁]）符合研究纳入标准——HPSD组80例患者（316条肺静脉[PV]），LPLD组80例患者（314条PV）。两组急性PV再连接的概率相似：HPSD组为2.2%，95%置信区间0.6%至3.8%；LPLD组为3.4%，95%置信区间1.4%至5.4%；非劣效性p<0.001。HPSD组的中位PV消融时间（20分钟对30分钟，p<0.01）和手术持续时间（80分钟对100分钟，p<0.001）较短。中位随访26个月后，两组间心律失常复发情况相似（HPSD组为17.5%，LPLD组为18.8%，p = 0.79）。
在采用消融指数治疗的阵发性AF患者中，HPSD策略不劣于更标准的LPLD消融，同时手术更快且消融时间更短。
